820321_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qual

Type of Visit: erCompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: Routine O Complaint 0 Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: /' Arrival Time: F3`', DZJ Departure Time: County:Region:
Farm Name: _ i� 7 �M_4
Owner Name: PzAt rV
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: Title: rh'
Onsite Representative: w 17f.f0
Certified Operator:p�y
Back-up Operator:
Location of Farm:
��. Phone:
Integrator:����
Certification Number:
Certification Number:
Latitude: Longitude:
1g
Current,
Design
Current
i3esign Current
ih
Capac�ty
Pop
I
� Wet Poultry
Capacity6
Pop.
Cattle Capacity PoSwme
to Finish
La er
Dai Cow
to Feeder
Non -La er
Dai Calf
r to Finish
Ei
N ::
Dai Heifer
w to Wean
p
.3 C7p
Design
Current
Cow
w to Feeder
D , I',onit ,
Ga aci
Po°t
Non-Dairvw
to Finish
La era
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
..., .
Turkey Poults
�
Other
Other
3
'��'IYl4Mwl,iIYNAMLIdS-M1-DYI:I._
-". -
[s }4ey'-
•"fir..
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes Q'Nio__ ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[:]Yes
[:]No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
[:]Yes
[3-No
❑ NA
❑ NE
Page I of 3 21412015 Continued

Facili Number: jDate of Inspection:
Waste Collection & Treatment
+
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure
6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[a'No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
�b
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental
threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
Or'<o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[3'N-o-
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[7No
❑ NA
❑ NE
maintenance or improvement?
Waste_ Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
EjlNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? if yes, check the appropriate box below. ❑ Yes [31go ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): c/MiOt
13. Soil Type(s): / max, &-y
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
[-]Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[ -N-o-
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑-'qo-
❑ NA
❑ NE
Reauired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[3-R-o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[-]Yes
❑N-o
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
[-]Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
Ed-N-o
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑'lq-o
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [? No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes EYNo 0 NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
�o
❑ NA
❑ NE
❑ Yes
[jNo
❑ NA
❑ NE
❑ Yes
aco
❑ NA
❑ NE
❑ Yes 0o ❑ NA ❑ NE
❑Yes Ej o ❑NA ❑NE
❑Yes
Ervo
❑NA
❑NE
❑ Yes
UjNo
❑ NA
❑ NE
❑ Yes
No
0 NA
❑ NE
❑ Yes
E3<o
❑ NA
❑ NE
�'!�/ 1 ` /T ,- �j �j�'>- �d Q off` r y : ^ �/�%a5• �S�/%a r--'7`C`, j ��.rr��
Reviewer/Inspector Name:— s �r� Phone:
Reviewer/Inspector Signature: Date: ��z --721
Page 3 of 3 2/4M15

I ype of visit: J<:7uompnance inspection v Uperatton Keview V structure rvaivanon V i econecai Assistance
Reason for Visit: outine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Imo_ J Arrival Time: ' j Departure Time: a .3 [? County: Jv� Region:
Farm Name: ��.t��� ^"�� Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: r/Mbde-r—n Title:
On site Representative: : ,% - Alpw/�tf
Certified Operator: /ZZP Crr2Z
Back-up Operator:
Location of Farm:
Latitude:
Phone: _
Integrator:
Certification Number:
Certification Number:
Longitude:
1Je5ign
Cnrrent
Design
Current
Desiign
Current
Swine
' •
s
Ca acE ty
P���;:
WetP,.oult , �
��,� ry n
Ca aci
p h'
Po p
C
rattle Capaci#y
Pap.
.,:
°�
.
E
C•
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
Non -Layer
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
a v
f3 mac?
Design
Cnrrent
Dry Cow
Farrow to Feeder
D P,oult .
LCa ei
Pao
Non-Dai
Farrow to Finish
Layers -
Beef Stocker
Gilts
Non -Layers
I
Beef Feeder
Boars
��
Pullets
Beef Brood Cow
Turke s
Other;.
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
[:]Yes EJNo ❑ NA ❑ NE
[:]Yes [:)No ❑ NA ❑ NE
❑ Yes [] No ❑ NA ❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? [:]Yes No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

]Facility Number: - `j Date of Ins ection: !;;Z— 7--1
l Waste Collection & Treatment
' 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Spillway?:
®No ❑NA ❑NE
❑No ❑NA ❑NE
Structure 6
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
allo
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
ELNo
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat,
notify DWR
7_ Do any of the structures need maintenance or improvement?
❑ Yes
�No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
KNo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[Q No
❑ NA
❑ NE
maintenance or improvement?
Application
_Waste
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
®, No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. 0 Yes PQNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s)= r/ cc /tg
13. Soil Type(s): 6_�;
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
®No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
(KNo
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
0 No
❑ NA
❑ NE
acres determination?
17.
Does the facility lack adequate acreage for land application?
❑ Yes
❑,No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
[Z No
❑ NA
❑ NE
Required
Records & Documents
19.
Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ No
❑ NA
❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[RNo
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? 1 f yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall [:]Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I " Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ® No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes El No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: - a Date of Inspection: /,-z _ —1 7
I 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ®-No ❑ NA ❑ NE
r
25. is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes E.No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes CR No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes R1 No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? if yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes K No [] NA ❑ NE
❑ Yes ®No ❑ NA ❑ NE
❑ Yes ®-No ❑ NA ❑ NE
❑ Yes ®. No ❑ NA ❑ NE
[:]Yes [RNo
❑ Yes 0 No
❑ Yes ® No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question #} E�pla 'iany. Y ES answers sndlor aQy addEt�onal recommendations _o� any other cow"Ments.
Use d"wrugs;al' facility.to better ez� ]AR situations "
r ..a ;
P (use additional pages ss'necessa
ry)
Reviewer/I nspector Name:
Phone: �jjp 3v3— of 5
Reviewer/]nspector Signature: Date:
Page 3 of 3 21412015

r
ivision of V1Watcr Resources
NEW 'um Number - Division of Soil and Water Conservation
Other Agency
Type of Visit: ompliance Inspection 0 Operation Review p Structure Evaluation p Technical Assistance
Reason for Visit: �utine 0 Complaint 0 Follow-up 0 Referral Q Emergency 0 Other 0 Denied Access
Date of Visit: / /
Arrival Time: : UO
Departure Time: c- Q I
County: , 5 � Region:
Farm Name:
Owner Owner Email:
Owner Name:��t/7-r�r/y�7�< ��L Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: s' r. �. Phone:
.. w f
Onsite Representative: Integrator:
Certified Operator: �f j �j� J�a �. �(j / r� /� Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
MyDesign
Current DesignSwineCapaciPop. Wet Poultr.-y - Capacity ;;,Pop. Cattle Capacity Pop.
to Finish
Dai Cow
MtoFeeder
Non -La er
DairyCalf
DairyHeifer
D Cow
Feeder to Finish'
arrow to Weans
O U
Design Current
Dry PouMR-w- a aci ,tPo .-
Farrow to Feeder
Non-Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Pullets
Turkeys
urkey Poults,
Otherv}
Beef Feeder
Beef Brood Cow
Boars
Othe
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b_ Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system'? (if yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes F&No ❑ NA ❑ NE
❑ Yes [:]No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes FNo
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Page 1 of 3 21412015 Continued

Facili Number: - 3 Date of Ins ection: /,-�Z— /L
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Eg No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):_
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes J&No ❑ NA ❑ NE
(Le., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes 0,No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA C] NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes �No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [R No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes CZ -No ❑ NA ONE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable CropWindow❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s): Crp
14. Do the receiving crops differ frcx those designated in the CAWMP?
❑ Yes
L&No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
�No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[ No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
J�C , No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
fg No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
E] No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists [:]Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
• ❑ Yes
E&No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I " Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge'?
❑ Yes
RNo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
f'Z71 No
❑ NA
❑ NE
Page 2 of 3
21412015 Continued

Facili Number: - Date of Inspection:
t. 24. Did the facility fail to calibrate waste application equipment as required by the permit?
'
❑ Yes
®-No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
0 No
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
Callo
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
P No
❑ NA ❑ NE
Other lssues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
�1No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
V1 No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
MNo
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
Callo
❑ NA
❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
FA
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
J�Q No
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Y� zf2 rct r13
1" /
Reviewerllnspector Name:
Phone:
Reviewer/Inspector Signature:
Date: /.�l
Page 3 of 3 21412015

Type of Visit: Momnl�nce Inspection U Operation Review O Structure Evaluation 0 Technical Assistance I
Reason for Visit: O%Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: p; 7--- Arrival Time: Departure Time: / ; a a County: Region: -� (D
Farm Name: �a/O� �Q r/�' Owner Email:
Owner Name: - �j L a �k R
Mailing Address:
Physical Address:
Phone:
Facility Contact: Title: T,o 2k12I. Phone:
/ a
OnsiteRepresentative: ��--a`� ( %"�'`f�dr� Integrator:
Certified Operator: 00//B /rL'%l Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Design
Current
Design Current
Swine Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Nan -La er
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
p
C7
Design
Current
Dry Cow
Farrow to Feeder
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
............
Qther
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
❑ Yes �No ❑ NA ❑ NE
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes ONo ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412014 Continued

Facili Number: - Date of Inspection: /p
/
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
r
❑ Yes
allo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): r 0
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
C. No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
[:]Yes
Eg No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
[KNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
Ej No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
gLNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes C3,No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence/of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): Z-r!::z"L"'fdc'_
13. Soil Type(s): (tea s ••_
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes Callo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes � No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes EK No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes No ❑ NA ❑ NE
[::]Yes gLNo ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes allo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 0 No ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [:]Yes [&No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ® No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [—]Yes MNo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 21412014 Continued

lFacHity Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes allo ❑ NA ❑ NE
i
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes allo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [:]Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes [a No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[ff No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
[:]Yes
[EgNo
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
[&No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
allo
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
El No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[&No
❑ NA
❑ NE
Comments (refer to question # 'dEiplatn anyNE&answers and/or any ladditionallrecommendiitionsloriny atl er comments.
Use.drawings=o facility to better _gxk 4 n,srtnittons (use additional pages as necessary). 4 4
Reviewer/Inspector Name:�"�_
Reviewer/Inspector Signature:
Page 3 of 3
Phone: } e,_9 !. —_33a,:D
Date: /" v2� 45J
21412014

i ype or visit. tgo-c.ompuanee inspection v uperation xeview tJ arructure Evaiunuou V iecnnicat Assistance
Reason for Visit: �outine Q Complaint O Follow-up O Referral O Emergency Q Other O Denied Access
Date of Visit: Arrival Time: Departure Time: .3(7 County: Region:
Farm Name: 9� -;� �ariyr� Owner Email:
Owner Name: f i90_ /__ae?' j �� C Phone:
Mailing Address:
Physical Address:
Facility Contact: Afoo/-r- Title: r-�7
Onsite Representative: ? a..� _ y � � per✓
101,
Certified Operator:
Back-up Operator:
e • Phone:
Integrator:
TT --
Certification Number:
Certification Number:
Location of Farm: Latitude: Longitude:
_ill Design
Swine Gapacity
Wean to Finish
Current
Pop.
Wet Poultry
Layer
Design
Capacity
Cqq urrent
Pop.
M
t
Cattle Capacity Pop.
airy Cow
Wean to Feeder
1EFeeder
Non -La er
airy Calf
to Finish
Dairy Heifer
Farrow to Wean lypgg 1Y CO
Dry Cow
Farrow to Feeder
Div P,oult
Ca sei
P,o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
other
lffkeZ Puults
Other
Other
Discharees and Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes jK No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes E�[No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3
21412014 Continued

` Facility Number: - 7Date of Inspection:
/
i. Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): 19-
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
5�_No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
[a No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental
threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
IR No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ZNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): 3*n^ t V J01
13. Soil Type(s): tom: r+-
14. Do the receiving crops differ from those designated in the CAW MP? ❑ Yes No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
I& Did the facility fail to secure and/or operate per the irrigation design or wettable C] Yes j. No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application? ❑ Yes [0 No ❑ NA ❑ NE
18. Is there a lack of property operating waste application equipment? [:]Yes ® No ❑ NA ❑ NE
Reauired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? C] Yes No
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No
the appropriate box.
❑WUP ❑Checklists ❑Design [:]Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ®, No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes G� No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [] Yes R No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facili Number: - Date of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 0 No ❑ NA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes Callo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? [:]Yes ® No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes 0 No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes [2 No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWW?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes [,No ❑ NA ❑ NE
❑ Yes �No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes
(2 No
❑Yes
®No
❑ Yes
RI.No
❑ NA ❑ NE
DNA ❑NE
❑NA ❑NE
Comments (refer to question ft Explain any YES answers'andlor.any additional: recommendations. or any other comments p
Use dra%ings of facility to better explain situations (use:additional.pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 9,-*~4Q 33cc,-
Date: &--/%
21412014

V✓
(Type of Visit: (9T=0'U':dne
ce Inspection Q Operation Review U Structure Evaluation Q Technical Assistance I
Reason for Visit: 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: :3 Departure Time: pa County:�V__ Region:
Farm Name: Owner Email:
Owner Name: JF�'i.Ws 116 Phone:
Mailing Address:
Physical Address:
Facility Contact: (�rPZ//Y+►r fi%b/`� Title:
Onsite Representative:
Certified Operator:
Phone:
Integrator:
Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Design.
Current
Design Current
Swine
Capacity Pop.
Wet Poultry
Capacity.
Pop.
Cattle :: Capacity Pap.
Wean to Finish
La er
DairyCow
Wean to Feeder
Feeder to Finish
on -Layer
{'
DairyCalf
DairyHeifer
Farrow to Wean
j o� cV
Design
Current
D Cow
Farrow to Feeder
Farrow to Finish
Gilts
D . Paul
Lavers
Non -La ers
Ca acity
P,o P.
Non -Dairy
Beef Stocker
Beef Feeder
Boars
Pullets
Turkeys
Beef Brood Cow
`
Other
TurkeyPoults
0 .
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑Yes ERNo ❑NA ❑NE
❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWQ)
[:]Yes
[:]No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
[—]Yes
No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facility Number: Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes P No
a. If yes, is waste level into the structural freeboard? ❑ Yes [:]No
Identifier:
❑ NA ❑ NE
❑NA ❑NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Spillway?:
Designed Freeboard (in): �f
Observed Freeboard (in): --3 5_
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 0 No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
0 Yes
Z No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
R No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
0 No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
® No
[DNA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance a]ternatives that need
[:]Yes
"No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? if yes, check the appropriate box below. ❑ Yes [XNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): Z�ym w
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes
n No
❑ NA
❑ NE
❑ Yes
0No
❑ NA
❑ NE
❑ Yes
� No
❑ NA
❑ NE
❑Yes ®No ❑NA ❑NE
❑ Yes 2No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes [g No ❑ NA [] NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check [:]Yes [3No ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Lallo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 0 No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [,No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of inspection: /;I- �-
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Wo
i
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes JA No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑Yes [No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes T� No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
® No
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
[] Yes
No
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
C,No
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
0 No
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[jj[No
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[�j No
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
V No
❑ NA ❑ NE
[DNA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question f: Explain any YES answers and/or any additional recommendations or any other commentsk."'
Use`drawvings of facility to better explain situations
(use additional pages as necessary).
yy/
it
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: %r/D "�f 33--37ao
Date: /J 7,-w_Z-0i3
21412011

l
Type of Visit: &Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: DHGutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: o County Region: /r__17D
Farm Name:
/-1—D
Gi
Owner Name:
k
; a/ c e - f:�r/rrrs
c-
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: C_1,07:.r Title: ��� , ram, Phone:
OnsiteRepresentative: Integrator: /r
Certified Operator: —<L plf�ll Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude: Longitude:
S'
wine
Desi n Cu nt
Ca � Po
p gty, p
Wet Poult ,
•ry
ICae cgn Current
p ity1?op.
Design Curren#
Ga#tle Capacity Pop.
Wean to Finish
airy Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
Farrow to Wean
3 a c
Design .Current
D Cow
Farrow to Feeder
Dry, Poul
Ga .act Po P.
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Beef Brood Cow
Pullets
Turke s
+.:.
Qther
T„,.;;-
Turkey Poults
Other
Other
DlscharPes and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
ELNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
CR�No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
® No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facility Number: - Date of Inspection:
Waste Collection & Treatment
I 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes P.No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): / �]
Observed Freeboard (in): ;�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
� No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
Q No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
M No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
� No
❑ NA
❑ NE .
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [] Yes Q No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
1
12. Crop Type(s): �tr�t+�ic— ,L j2 vrrSYr-�
13. Soil Type(s):
14. Do the receiving crops differ from t1iose designated in the CAWMP?
❑ Yes
[allo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement`?
❑ Yes
® No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
0 No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
� No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
®- No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
® No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design []Maps ❑ Lease Agreements ❑Other:
21 _ Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [g No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes '6 No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes � No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 21412011 Continued

Facili Number: - 3 Date of ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA r] NE
i 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ® No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 10 No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes ® No ❑ NA ❑ NE
❑ Yes (4 No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes N No ❑ NA ❑ NE
❑ Yes [o No
❑ Yes ® No
[:]Yes CSNo
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
Comments (refer to question # ): Explain any YES.. answers and/or. any additional. recommendationsjor.-any otbeKcomments.'
Use drawings of facility, to. better explain situations`(use additional. pages as necessary). x r.
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Phone: 9Jp-y 2--'V300
Date: l.;L L/ _1__A0/�
21412011
Page 3 of 3

- ivis-ion of Water Quality ��
Facility Number ®- � � Division of Soil and Wa#er Conservation
O Other Agency
Type of Visit: ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
I I y _
Date of Visit: Arrival Time: �1 Departure Time:
Farm Name: Hie�yr
Owner Name: �� -R; v-er
Mailing Address:
Physical Address:
Owner Email:
Phone:
County Region:
Facility Contact: Title: _ Phone:
Onsite Representative: Cyr :,049L--- , �; ,�y /00,01-V- _ Integrator: oWyr
Certified Operator: 12KIV Certification Number:/
Back-up Operator: el Certification Number:
Location of Farm:
Latitude:
Longitude:
t
Curr�Pop.Tj
�:
Design' ;Current
Design Current
�ees_gn
ci h"
Wet P.,ouIt
Ca act
' P tyop
P.
Cattle Capaci
Wean to Finish
La er
DairyCow
Wean to Feeder
Non -Layer
DairyCalf
Feeder to Finish
Farrow to Wean ao
-" -
I.
-
Design
4 '�'
.Current
Dai Heifer
D Cow
Farrow to Feeder
D P,oult .
Ca aci
Po _
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Seef Brood Cow
_
Wither _
Other -I
—.Turkeys
Turkey Poults
10ther
Discharves and Stream Impacts
1. Is any discharge observed from any part of the operation?
[:]Yes
[&No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
[:]No
❑ NA
0 NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2_ Is there evidence of a past discharge from any part of the operation?
❑ Yes
2 No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[] Yes
® No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facili Number: IV= - 324 Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[3 No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
[R No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): j g
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
❑ No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
[K] No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
6 Yes
, 7'No
❑ NA
❑ NE
& Do any of the structures lack adequate markers as required by the permit?
❑ Yes
Callo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
[:)Yes
® No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
C5 No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
0 No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved
Area
12. Crop Type(s):f�xrcett
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ® No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [Z No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes Q No ❑ NA ❑ NE
❑ Yes [R No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? [:]Yes Q No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ Yes allo ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design [:]Maps ❑ Lease Agreements [—]Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall [:]Stocking [:]Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes R No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [LNo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

IFacWty Number: - Date of Inspection: /L
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes M No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ®No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes � No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [a No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes ® No ❑ NA D. NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes [4 No ❑ NA ❑ NE
32_ Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
® No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
WGM No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
®No
❑ NA
❑ NE
Co drams (r fer to question
t b # Explain an YES answers and/or an additional recornmendatrons6or any1o#tier comm "' Comments refer to uest<o } p y y ents.
etter explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 9yQ- :3t 0
Date:
21412011

U
(Type of Visit: 0 Compliance Inspection O Operation Review UStructure Evaluation 0 Technical Assistance i
Reason for Visit: O Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 10 0ther 0 Denied Access 11
Date of Visit: Arrival Time: T� ,� Departure Time: L County:
FarmName: /rye _ r_ - Owner Email:
Owner Name: r lZ'a—"— Fa✓rw< LL C Phone:
Mailing Address:
Physical Address:
Facility Contact: 17✓ nL Title: Phone:
Onsite Representative: _15-_�
Certified Operator: sue_
Back-up Operator:
Location of Farm:
Latitude:
Integrator: ���J
Certification Number:
Certification Number:
Longitude:
Region:
_.
Design Cpp ent, �lWet Pot � Desi35C�iuiSwine Capa
Layer
Non -La er
Design Currentx
D > Poul -_: Ca aci POD.
CattleWCapacity Pap.
Da' Cow
Dai Calf
Heifer
Cow
Non -Dairy
Layers
Beef Stocker
Non -Layers
Beef Feeder
Pullets
Beef Brood Cow
Other
Turkeys
TurkeyPouets
Other
Other
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Discharges and Stream impacts
. Is any discharge observed from any part of the operation?
❑Yes
❑ No
❑ NA
ONE
Discharge originated at: ❑Structure ❑Application Field ❑Other:
a. Was the conveyance man-made?
[]Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑Yes
❑ No
❑ NA
� NE
3_ Were there any observable adverse impacts or potential adverse impacts to the waters
❑Yes
❑ No
❑ NA
Eg NE
of the State other than from a discharge?
Page I of 2/4/1011 Continued

Facili Number: - I Date of Inspection: 3
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [,No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No
[] NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do -any of the structures need maintenance or improvement? Yes ❑ No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ® No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ® No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No
❑ NA
aNE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ NA
E,NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13_ Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ❑ No ❑ NA ER -NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ❑ No ❑ NA E[ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ❑ No ❑ NA RNE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes 0 No ❑ NA jg� NE
❑ Yes ❑ No [] NA V1 NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA ® NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA EaNE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [-]Yes [—]No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No
❑ NA ® NE
❑ Weather Code
❑ Sludge Survey
❑ NA M NE
❑ NA ONE
Page 2 of 3 21412011 Continued

,. lFacWtv Number: - 3'�L[ I I Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No ❑ NA [ANE
' 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
❑ No [] NA ® NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
❑ No 0 NA fa NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
❑ No ❑ NA RNE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
❑ No ❑ NA L&NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
❑ No
❑ NA
[U NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
[]Yes
❑ No
❑ NA
[S NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ NA
[B NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ No
❑ NA
aNE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
® No
❑ NA
i�
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
�No
❑ NA
❑ NE
Commentsm.(refer to uestion Ex lain as YES answers and/or any additional recommendation§` ar any ot1 ei= com—"---its.
q � A. Y _ _
Use iirawin>:s-oflfacilit_y to tietter explain situations (use additional liaises as necessary) , .
Tv `ao k/r�s r- Lv�l�� �✓���k•�
?-" y work
r'G64r)C_ W' ! 1 be~tr-
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: /D
21412011

Type of Visit (D,ompliance Inspection ()Operation Review (-)Structure Evaluation U Technical Assistance
Reason for Visit outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region: LQy
Farm Name: sJ'2� a-r�_ Owner Email:
Owner Name: Fa&Ikrr -s LG Phone:
Mailing Address:
Physical Address:
Facility Contact: Aloye=. Title: _ 1 �th� '�v��. Phone No:
Onsite Representative: Integrator: Axi m�
Certified Operator: `fit a�/`!L= Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: 0 ° �' �" Longitude:
Design CurrentDesign
!Ee
Current
Cap ty Population Cattle
Design Current
Capacity Population
to Finish
❑ La er
❑Dai Gow
to Feeder
❑ Feeder to Finish
C�lf to Wean
❑Non -La er
❑ Dai Calf
'0-� I g
"x
Dry PoultryUn
❑ La ers
ElElBeef
-La ersPullets
❑ Turkeys
❑ Turke Poults
❑Other
❑Dai Heifer
❑ D Cow
❑Non -Dairy
Stocker
ElBeef Feeder
10 Beef Brood Cowl
Humber of structures:
❑ Farrow to Feeder`
❑ Farrow to Finish
EGilts
Boars
Other
❑ Other
,...-,it
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
ZLNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. is there evidence of a past discharge from any part of the operation?
❑ Yes
M No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
[&No
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

Facility Number�—,3;2Date of inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes RNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in);^f g
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [N No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes E9 No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes (ZNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ yes S No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
maintenance or improvement? El Yes NO El NA ❑ NE
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ZI No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 93-No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13.
Soil type(s) e_ '2, ,-
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
CgNo
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
[&No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?Q Yes
[ZNo
❑ NA
❑ NE
IT
Does the facility lack adequate acreage for land application?
❑ Yes
RNo
❑ NA
❑ NE
18.
is there a lack of properly operating waste application equipment?
❑ Yes
E?LNo
❑ NA
❑ NE
Reviewer/Inspector Name Phone: 3330-o
Reviewer/Inspector Signature: Date:
{ 1LSC 1 J {!r/L 1 �V���aI�RFIf

Facility Number: XL� j Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes JRNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes KNo ❑ NA ❑ NE
the appropirate box. ❑ W­Up ❑ Checklists ❑ Desig
n ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes QNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
® No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
ERNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
allo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
KNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
&No
❑ NA
❑ NE
27_
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[RNo
❑ NA
❑ NE
Other Issues
28_
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
EgNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
RNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
RNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
RNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
allo
❑ NA
❑ NE
Page 3 of 3 12128104

_8T,7Af_.1; /Z -2Z- Zoo 9
Type of Visit (!rCompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit 8routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: y:�0� County: SQwirlSO" Region: LiOO
Farm Name: 8dr`e-�o�+ Farw. Owner Email:
Owner Name: �t�-k Riyc_y- Fo_trv.,._5 L L-C. Phone.
Mailing Address:
Physical Address:
Facility Contact: Gre�'r moo° ram— —Title: ��� � SP 4P-C— Phone No:
�i wow. 1t/Co
Onsite Representative: a O r Integrator:
Certified Operator: MaaKi— J a.,14 _5 C. Operator Certification Number: 22_'?LD O
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = 0 0 [ = " Longitude: = O =, = "
Design Current Design
Current Design Current
Swine Capacity Population Wet Poultry Capacity
Population Cattle Capacity Population
❑ Wean to Finish ❑ La er
❑ Dairy Cow
❑ Da' Calf
❑ Dairy Heifer
❑ Dry Cow
to Feeder
❑Non -La er
EElWean
Feeder to Finish
/300 113106Dry Poultry
® Farrow to Wean
❑ Farrow to Feeder
❑ La ers
❑Non -La ers
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
❑ Pullets
❑ Beef Brood Cowl
❑ Turkeys
Other
❑ Turkey Poults
Number of Structures: 1
❑ Other ❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes E No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made? ❑ Yes ❑ No ETNA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes ❑ No ffNA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes Nam❑ NE
2. Is there evidence of a past discharge from any part of the operation'? ❑ Yes A NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State ❑ Yes No A ❑ NE
other than from a discharge?
12128104 Continued

i '.
Facility Number: $2-3z Date of Inspection ►Z "►�-�
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
❑ NA
El NE
a. If yes, is waste level into the structural freeboard?
El Yes VNo
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: Lai
Spillway?:
Designed Freeboard (in): / 9
Observed Freeboard (in): 31
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes LI No
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental thr at, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes L'J No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 2 No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes LJ lslo ❑ NA ❑ NE
maintenance or improvement?
Waste Application ,�,�
10. Are there any required buffers, setbacks, or compliance alternatives that need El Yes EJ NO ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes �No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) &-r-OA— d 0.. (140-1) j S w..a U G re.i r.t (o • S
13. Soil type(s) Ca i ti k o c{ Ccczg )
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 9 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes I1No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes dNo ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes [2< ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment`? El Yes LYd No ❑ NA ❑ NE
Comments (ei fer.to:.questioii#): Explain any YES answers and/or any recommendations or any other comments
Use drawrngs oifacility to better explain situations: (vise additional' pages as.necessary) wFnt
Reviewer/Inspector Name � � .(� ',. cUc' S ?. Phone: 910, V-3-3i3300
Reviewer/inspector Signature: e*-� Date: f Z- /7-z0o9
12128104 Continued

Facility Number: 82 — 3Z 1 Date of Inspection
Reguired Records & Documents
IN,
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes
M
El NA
El NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ NA
❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
LJ No NA
El NE
El Waste Application El Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
AnnCertification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I"
Rain Inspections Q Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
N
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
L_J No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
El NA
El NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
[I Yes
VNo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
ONo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
ffNo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
B No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
DNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
^^/
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
o
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
El Yes
,R
0<0
❑ NA
❑ NE
Addjtioaal Commetits°andl�or�Drawxngs: '`
H
12128104

t
/3ze% s
/-08 —o9 R2—
Type of Visit (�r_Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit GHCo-utine O Comp€aint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: 1 /Z Arrival Time: Departure Time: County: .S4 S6^t Region: F
Farm Name: L:�&rz_-4c, Y Owner Email:
Owner Name: Z[ack- Q ov w fa­-r—S LL C Phone:
Mailing Address:
Physical Address:
Facility Contact: _ G ru-4.Mz r c— Title: Phone No:
Onsite Representative: J th+'��aj"� Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = e = t ET Longitude: = ° 0 ' ❑ "
Design Current
d
Design Current
Design Current
Swine Capacity Population
Wet Poultiy ` Capacity Pope 1 tion
Cattle Capacity Population
�.
❑ Wean to Finish
❑ Layer
❑ Dairy Cow
❑ Wean to Feeder
❑ Non -Layer
❑ Dairy Calf
❑ Feeder to Finish'
<s
❑ Dairy Heifer
Farrow to Wean / oa
`��
I) . Point
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
❑ Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Co
❑ Turkeys
-
Other
❑ Turkey Foults
❑ Other
❑ Other
Number of Structures:
Discharges & Stream Impacts
1 _ Is any discharge observed from any part of the operation?
❑ Yes
�lo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
['NA
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
❑ Yes
❑ No
B-5-A
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
,��
ETNA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
D-1 o
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
E No
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

r
Facility Number: gZ — .�2 / Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes B E o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ET'No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: L-t5 I
Spillway?: 140
Designed Freeboard (in): 1 9
Observed Freeboard (in):Z
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes M o ❑ NA ❑ NE
(ic/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ETNo ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes [31�o ❑ NA ❑ NE
S. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
["No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes
[3,Ko
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
0-igo
❑ NA ❑ NE
maintenance/improvement?
IL Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
9- o
El NA El NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[]PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) l�wr.. �� (N� Sw�l� t9ree; t`O - S
13. Soil type(s) C -ek
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
E3 o
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
0-154o
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
El NA ❑ NE
17. Does the facility lack adequate acreage for land application? [3 Yes
,3'No
L �,<
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
[liqo—
❑ NA ❑ NE
IR
Reviewer/Inspector Name F_1 , �, Kw Phone: 9/0, 4/33 .'3 33 a
Reviewerhnspector Signature: Ras...4' Date: /2 -/& -zoos
Page 2 of 3 12128104 Continued

i
Facility Number: 92 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ['No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ Yes []"No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps El Other ��
21. Does record keeping need improvement? If yes, check the appropriate box below. El Yes LJ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22_
Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑'No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
["No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ NA
El NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
El Yes
��o
�.]No
ElNA
ElNE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
D <
❑ NA
❑ NE
27_
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
EK
❑ NA
❑ NE
Other Issues
28_
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
LI 1No
ElNA
ElNE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
Yes
El2
Info
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
El Yes
��
o
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
©Ko
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
E3 o
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
EK
❑ NA
❑ NE
Addifional Coients and/or Drawings:
Page 3 of 3 12128104

is
S ,c*vk.,c,4 0/1O y12008
( rbivision of Water Quality
Facility Number I $Z 3z� O Division of Soil and Water Conservation
O Other Agency 11
Type of Visit l&'Cmpl' nce Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit oRoutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: /2-R-07 Arrival Time: Departvre'I'ime: 3.I5 .,,� County: 5gtjp50nt Region:
Farm Name: �c�V-e-'I`�df °'� Owner Email:
Owner Name: 31ack— WV"' I:q vms LLC.
Mailing Address:
Phone:
Physical Address:
Facility Contact: Title: 1 SPeL Phone No:
Onsite Representative: Integrator: lgrzfw"
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
. a
Latitude: [—] o = ' = « Longitude: El o = ' ❑
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
Farrow to Wean i300
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ La er
❑ Non -La et
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Da Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures: ED
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ® No ❑ NA ❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
No
❑ Yes
[M No
❑ NA
❑ NE
❑ Yes
8 No
❑ NA
❑ NE
12128104 Continued

Facility Number: S2 -32 I,
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1
Identifier: _W I
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
Structure 2 Structure 3 Structure 4
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc_)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes [)] No
❑ Yes [2 No
Structure 5
El NA ❑NE
❑ NA ❑ NE
Structure 6
❑ Yes [9 No ❑ NA ❑ NE
❑ Yes [I No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes [6 No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
❑ Yes E] No ❑ NA ❑ NE
❑ Yes 1 ! No ❑ NA ❑ NE
❑ Yes No
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes [A No
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
El NA El NE
❑ NA ❑ NE
12.
Crop type(s)
13_
Soil type(s) Ca-E>
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[ No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑
Yes
(f] No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
0 No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
® No
❑ NA
❑ NE
IComments (refer to question ft Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name RiGktj JZC-4 e_l S Phone: ctJO, 4,33. 33-00
ReviewerfInspector Signature: �?_ Date: IZ—IZ —Z00?
12128104 Continued

Facility Number: 97— -3Z! Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ® No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [0 No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[ No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
[�j No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[P No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
® No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[� No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes]
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
® No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
F No
❑ NA
❑ NE
Comments and/or Drawings:
12128104

E
Type of Visit 0 Compliance Inspection 0 Operation Review U Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: nArrival Time: Q Departure Time: �� �Zp County:/�Sey Region:
Farm Name: �Ve-'fft��o 0 FGy .11 Owner Email:
Owner Name:_ RiU,.✓ _ F&Vh-%- Phone:
Mailing Address:
Physical Address: 'I ,
Facility Contact: re-c_v- Yui o ar L Title: Phone No:
Onsite Representative: Azu,', Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: 1--] e =] { = u Longitude: = o =1 = "
Swine
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
Design Current
Cattle Capacity Population
❑ Wean to Finish
❑ Layer
❑ DairyCow
❑ Wean to Feeder
❑ Non -La er
❑ DairyCalf
❑ Feeder to Finish
arrow to Wean
3 Dry Poultry
❑ La ers
❑Non -La ers
❑ Pullets
El Turke s
❑ Turkey Poults
❑Other
❑ Da' Heifer
❑ D Cow
Non -Dairy
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
❑ Boars
Other
Number of Structures: EE
❑ Other
Discharges & Stream Im acts
1. Is any discharge observed from any part of the operation'?
❑ Yes
EYNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
VFNo
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
O No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
IRNo
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[ WNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
[;iNo
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

i
Facility Number: Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes VNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes [A No ❑ NA ❑ WE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier:
Spillway?: �A10
Designed Freeboard (in): —
i
T
Observed Freeboard (in): 32
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
® No
❑ NA ❑ WE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
No
❑ NA ❑ WE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes
PD No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
J9 No
❑ NA ❑ WE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes
No
❑ NA ❑ WE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
PNo
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
,,��qq
A No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) 15 cj'I+�td c2_ J./wu
13. Soil type(s) s
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
VNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
q No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
[ No ❑ NA
❑ WE
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ WE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[P No
❑ NA
❑ WE
Comments (refer to question #): Explain any YES answers and/or any recommendations or anyyother comments i
- �.
Use drawings 6f facility to better explain situations. (use additional pages as necessary):z
Reviewer/Inspector Name K i C— KL' Phone: (Mo) S/33-3330
Reviewer/Inspector Signature: ZIIAJ.r� Date: /a —/O — aacl G
rage z of 3 (L/6d/V4 uonanuea

r
1
Facility Number: Z — Z Date of Inspection Odd O
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [jNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CA W M P readily available? If yes, check ❑ Yes Ej No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes V'No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall [:]Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes Z No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes �FNo ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
"No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
M No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
VNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
�No
❑ NA
El NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
VNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
P?No
❑ NA
❑ NE
Additional';Comments and !r.,Drawings:
i
Hw
Page 3 of 3 12128104

f
r
Type of Visit ® Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit O Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: p County: .a S a h Region: �� d
Farm Name: �aY 7 00�Qv Owner Email:
Owner Name: n I a ar �av u�_5 %:. C Phone: qtO - 3 2- tj,24
Mailing Address: ?0 a Zi
Physical Address:
Facility Contact: On %r moo'- & a C. r e — Title:
On site Representative: C1r. t e e M Q o lr !. S, : 18deI"C
Certified Operator: �Sa e i k D o r{
Back-up Operator:
Phone No:
Integrator:
Operator Certification Number: , 2 OO
Back-up Certification Number:
Location of Farm: Latitude: = = g = Longitude: = ° = S [� I,
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population;
❑ Wean to Finish 10 Layer
ElWean to Feeder El Non -Layer
❑ Feeder to Finish
[Farrow to Wean
1130 0
R
❑ Farrow to Feeder
U Farrow to Finish
❑ Gilts
❑ Boars —
Other
❑ Other
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
I. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ IDLY Heifei
❑ Dry Cow
❑ Non-Dai
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (1f yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes [gfio ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
51'No
❑ NA
❑ NE
❑ Yes
ErNo
❑ NA
❑ NE
12128104 Continued

r %
Facility Number:2 ( Date of Inspection
Required Records & Documents !!
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ElYes M'wo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes QVio []NA ❑ NE
the appropriate box. ❑ Wup ❑ Checklists ❑ Design El M ❑ Other
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ W.e®19y+Terbvard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ ion
❑ Reirrwr ❑ Swakirfg ❑ Crap4feid ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
53 No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[TNo
❑ NA
❑ N
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
El NA
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
© No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
EINo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
E No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
® No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
9No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
9No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
El Yes
, �/
E3rNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
EdNo
❑ NA
❑ NE
a
a.�Y Fs�a-fit re r a-- •�7�' So 4'vf Spa t �t 6raf•`a .� ci�a ¢ h�vrr y �a�er.
I2128104

f `
Facility Number: i?2 —3 1 Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
ENo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): /
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
UNo
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6_ Are there structures on -site which are not properly addressed and/or managed
❑ Yes
[;�No
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
[9 No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
EP No
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
UNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[]Yes
MNo
❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 9No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 1 O lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind
pDrifl ❑ Application Outside of Area
12. Crop type(s) 19ot 4 cS tn„� (� v A
13. Soil type(s) L? A
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ENo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [,!,, No El NA El NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination`[] Yes L/No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes R o ElNA [INE
P
18. Is there a lack of properly operating waste application equipment? ❑ Yes o ❑ NA ❑ NE .
MINI
/`din S C Sdo<<
Reviewer/Inspector Name (v;� , Q� �" T ^Y Phone: 114? ► �l �G - /.!✓�l
Reviewer/Inspector Signature: Date: Zj—,Zd - o J'
12128104 Continued

I
Type of Visit A Compliance inspection O Operation Review O Lagoon Evaluation
Reason for Visit • Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: � Time:
O Not rational Q Below Threshold
Permitted 0 Certified [3Conditionally Certified © Registered Date Last Operated or Above Threshold: _---------
Farm Name: . Q - ------- -- --- —Count
Owner Name: r LL PhoneNo: S-. - y 7�
.....�$I.�.e�..----......t.,!�f --_ ....�...erg.�._......_.../_.�._...._.......�__.... ....---.�1.....-=-...........—..................�...........................
Mailing Address:.
Facility Contact: .. 4'"1 �� mQof.L....�_ . .. Phone No:
_ ....... Title:.. ,.._.� �... _ -- -- - ---,�y.1 D•_ �� .... _ ..
Onsite Representative:..G��eC_....: �1� �... � ,r!�.......1!l0 .0................. Integrator. [ c!i '-.: �1g4!!!� .... ... ------- --
Certified Operator:. . . ............. . .... . .... . Operator Certification Number:
Location of Farm:
(Kwine ❑ Poultry ❑ Cattle ❑ Norse Latitude • 4 " Longitude & 4 «
Des. in
Swine
[irieui x�"
iulation =�` _Cafde =:
- Wean to Feeder
Layer
Feeder to Finish
❑Non -Layer
arrow to Wean
-- `"
Farrow to Feeder
Other
Farrow to Finish
=TOtal DeSIj
Gilts
Boars
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made'?
!U Non -Dairy
.t
r -•
m capadty ::
o#aI=SSLW ^C
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: ...... �[... ......... ........... ___ _ - - . W ....
Freeboard (inches):
D"
❑ Yes Cygo'_
❑ Yes 340
❑ Yes
[3110-
0 Yes ❑So"
❑ Yes Bl�o
❑ Yes [1io
❑ Yes �o
Structure 6
12112103 Continued

Facility Number: — ?
Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes L7 6o
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes [<Fo
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes 9-Ko--
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes 0o
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level [] Yes 040
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes RTgo
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes 9N-0
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type BPi'73�Y_ 7t"a_& (-Min oyercee -
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWNIP)? ❑ Yes e1fo
14. a) Does the facility lack adequate acreage for land application? ❑ Yes PNo
b) Does the facility need a wettable acre determination? ❑ Yes 0,No
c) This facility is pended for a wettable acre determination? ❑ Yes Blgo
15. Does the receiving crop need improvement? ❑ Yes EW6
1
16. Is there a lack of adequate waste application equipment? ❑ Yes E>To
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ❑.Pin
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes [U Nv
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes [�o
Air Quality representative immediately.
Reviewer/Inspector Name
Reviewer/Inspector Signature: �, .►�„Lr Date:
12112103 Continued

r
Facility Number: 2 Date of Inspection L TJ
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/,r, c sts,Aesfg"n, m&ps; etc.)
❑ Yes
❑#b
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
leo
❑ VAestc Appbcaf= ❑Xr d ❑ iV wA@Anabps� ❑ Soil Sampling
24. is facility not in compliance with any applica le setback criteria in effect at the time of design?
❑ Yes
QNo
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes
G-Nb
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(iel discharge, freeboard problems, over application)
❑ Yes
[3NO
27_ Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
[}No
28. Does facility require a follow-up visit by same agency?
❑ Yes
E #M
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
[}No'
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
❑ Yes
Leo
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
32. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
33. Did the facility fail to conduct an annual sludge survey?
❑ Yes
❑ No
34. Did the facility fail to calibrate waste application equipment? ❑ Yes ❑ No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1 " Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
© No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
12112103

Site Requires Immediate Attention: tV0
Facility No. Sz - 3 21
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: 7- Z-7 , 1995
Time: /I - {$
Farm 1
Mailing
County
Integral
On Site Representative: 66nA Vl "4 Phone:
Physical Address/Location: Ape &-�-. Z t42-, " -% a.'s s ;,,j e�
067 It
Type of Operation. Swine Poultry Cattle
Design Capacity: _���F Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: Longitude: «
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) Yes or No Actual Freeboard:-3—Ft. b Inches
Was any seepage observed from the Ia oon(s)? Yes or®Was any erosion ob ed? Yes or?
Is adequate land available for spray? Ye or No Is the cover crop adequate? �or No
Crop(s) being utilized: C
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellin s? or No
100 Feet from Wells? Y s or No
Is the animal waste stockpiled within 100 Feet of USGS Blue.Line Stream? Yes or &
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes orN
Is animal waste discharged into water of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or& If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? & or No
Additional Comments:
_ RJGk4i GVC/S
Inspector Name - -- - --
/?-
Signature
cc: Facility Assessment Unit Use Attachments if Needed.

REGISTRATION FORM FOR ANIMAL FEEDLOT OPERATIONS
Department of Environment, Health and Natural Resources
Division of Environmental Management
Water'Quality Section
If the animal waste management system for your feedlot operation is
designed to serve more than or equal to 100 head of cattle, 75
horses, 250 swine, 1,000 sheep, or 30,000 birds that are served by
a liquid waste system, then this form must be filled out and mailed
by December 31, 1993 pursuant to 15A NCAC 2H.0217 (c) in order to be
deemed permitted by DEM. Please print clearly.
Farm Name • a�eoT /'��-�
Mailing Address:
County: _4n..ti!_ce.v• ..` Phone No.Qi�-S�d-
Owner (s) Name:
Manager(s) Name: �...
Lessee Name:
Farm Location (Be as specif'c Po sible: road names, -direction,
milepost, etc.) /;► EC �/ a...i.-s
Latitude/Longitude if known: �.sl/ ,-D�7-D�-iO-Q
Design capacity of animal waste manageme t system (Number and type
c= confined animal (s)) : '
.S / .,s
Averaqe animal population on the farm (Number and type of animal (s)
Year Production Began: QD ASCS Tract No.:
Type of Waste Management System Used: "
Acres Available for Land Application of Waste: -20
Owner (s) Signature (s) : DATE:
DATE:

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